By: Yoram Padeh, M.D.
Asthma & Allergy Associates of FL
There has been a strong stigma associated with asthma for years, which has caused patients and physicians alike to shy away from the diagnosis. However, I learned that if you do not make the diagnosis, you cannot treat the patient properly. The medical definition of asthma is “reversible airway obstruction”. This means that if someone has tightness of their airways which can be improved by giving a medication designed to open the airways, then that person has asthma. Asthma can also appear for the first time at any age, as up to 22% of new asthmatics are over the age of 65.
A common misconception is that asthma symptoms need to be constant (persistent). Asthma can in fact be intermittent as well as persistent. Also, not every person with asthma needs to have the same symptoms. These symptoms can include one or more of the following: coughing, chest tightness, chest pressure, wheezing, shortness of breath, mucus production (from the chest). Yet not every asthmatic has the same type of inflammation in their airways. Newer treatments are being developed to target more specific types of asthma.
In years past, people with asthma, especially children, were forced to sit out from physical activity with their friends, whether at school or at home, which led to significant social stigma its consequences. Today this is no longer the case. Many of my patients are surprised to learn that up to 10% of Olympic athletes and other world-class athletes have asthma! This is due to the many simple and effective treatments available today. However, asthma medications only work when taken as directed. Cutting corners or forgetting does not lead to the same results. Additionally, exercise has been shown in medical studies to improve lung function and even reduce the need for asthma medications in a person with asthma. But exercise can only be performed safely by a well-controlled asthmatic. Finally, by knowing their triggers; which include infections, allergies, and weather changes; asthmatics can avoid the triggers or prepare for worsening symptoms with medication changes.
Asthma medications come in two categories: controllers and rescue. All patients with asthma need to have a rescue medication commonly an albuterol inhaler. This is used any time the patient experiences a flare of their asthma symptoms. One or two puffs from the inhaler can reduce or resolve the symptoms within minutes. A patient who only has intermittent asthma may need only a recue inhaler and nothing else. A patient with persistent asthma will need to be on at least one daily controller medication, in addition to having a rescue inhaler at hand.
When a patient with asthma experiences a flare in their asthma they will likely require adding a controller medication or increasing the dose of their usual controller medication until the flaring symptoms subside. They will also need to use their rescue inhaler more frequently to control symptoms until the additional controller medications take effect. Once the flare passes, the patient returns to their usual daily routine of medications; what they were taking before the flare started.
Recently some newer “biologic” medications have been developed which are either injectable into the arm (subcutaneous) or into the vein (intravenous). These medications are generally reserved for patients who are not well-controlled with the typical inhalers and require something more powerful. These medications are also used when patients need to be on oral steroids frequently or even constantly to keep their asthma symptoms controlled. While oral steroids work, they can cause many serious side-effects which can even become permanent. Therefore, these biologics have been created to reduce or eliminate the need for oral steroids. Also, the biologics are designed to treat very specific types of asthmatics who have very specific types of inflammation in their lungs. Determining the type of inflammation usually involves a blood test. It is important be aware that biologics carry their own side-effect profile which needs to be reviewed by the doctor with the patient.
Last but not least, certain asthmatics can be treated with allergy shots. Just as with the biologics, asthmatics that would benefit from allergy shots must be selected as those who have allergies. While some asthmatics clearly report allergic triggers of their asthma, not all asthmatics are aware of the allergic component. This is often because the exposure to the allergen may be “hidden” or less obvious. For example, an allergy to cats has been shown in the literature to be highly linked to having asthmatic symptoms. However, people often do not realize that a cat does not need to be present for a person to have an exposure to cat dander. This is because cat dander sticks to the clothing of people who have cats at home, and are released into the air wherever they go. So cat dander can be encountered in any social setting, including at school, at work, at parties, on airplanes, or at any other social gathering. Therefore if an asthmatic is found to have allergies by allergy testing (can be by skin or blood), then allergy shots may improve their asthma symptoms. In the best-case scenario, allergy shots can sometimes even eliminate the need for mediations altogether. Allergy shots will be discussed in more detail on its own in a future column.
Please note that this information is meant to be for general education and should not be taken as a specific recommendation for a particular person. For more specific information regarding a person’s specific asthma symptoms and how to achieve control, please schedule an appointment with a doctor.